Association of adiponectin and leptin-to-adiponectin ratio with the function of platelets in morbidly obese patients.

Adipokines regulate glucose homeostasis, insulin sensitivity, lipids metabolism, reproduction, as well as endothelial and platelets function. The study compares the plasma and adipose tissue concentrations of total adiponectin, leptin, leptin receptor and leptin-to-adiponectin ratio (LAR) in morbidly obese patients. Additionally it evaluates selected adipokines (leptin, adiponectin), endothelial markers and LAR depending on the gender in morbidly obese and non-obese subjects. The study involved 51 patients (31 women aged 21 - 60 (mean age of 39) and 20 men aged 24 to 60 (mean age of 41)). The eligibility criterion included the BMI ≥ 40 kg/m2. The non-obese group consisted of 30 healthy volunteers with the BMI < 24.9 kg/m2; nineteen women, aged 24 - 53 (mean age of 41), and 11 men aged 21 - 52 (mean age of 38). In the plasma and adipose tissue, the concentrations of total adiponectin, leptin, leptin receptor and plasma soluble forms of E-selectin, P-selectin, thrombomodulin were measured applying immunoassay techniques. There were noted significantly higher plasma leptin and sE-selectin concentrations, leptin-to-adiponectin ratio, additionally lower concentrations of plasma leptin receptor and sP-selectin in obese subjects regardless of the gender. Significantly higher concentrations of total adiponectin, leptin, leptin receptor expressed per 1 mg of total protein in adipose tissue, as compared to plasma in morbidly obese patients, were observed. Significant positive correlations between the BMI and the concentration of leptin and between total adiponectin and sP-selectin were reported in the subject group. Similarly there were noted significant negative correlations between leptin receptor and the BMI and between leptin-to-adiponectin ratio and sP-selectin in obese patients. The study has shown that adiponectin has a positive impact on platelets through a possible reduction in sP-selectin, and thus on platelets activation. On the other hand an elevated sE-selectin reveals perspective about the endothelium stimulation and a higher risk of endothelial damage in morbidly obese patients. Also in morbidly obese the higher leptin level and leptin-to-adiponectin ratio and simultaneously lower concentration of leptin receptor are associated with leptin resistance, additionally in possible future risk of insulin resistance and diabetes type 2.

The effect of cause of cadaveric kidney donors death on fibrinolysis and blood coagulation processes.

BACKGROUND: Organ donors can be generally divided into two groups according to the cause of their death. The first group is composed of those who died because of physical injuries, especially road traffic injury, and the second group, those who died from central nervous system (CNS) stroke or bleeding. The aim of our work was to examine hemostatic processes among kidney donors. MATERIALS AND METHODS: The 38 deceased kidney donors (KD) included 11 women and 27 men of overall average age of 37±12 years. The donor group of according to the cause of death, included 14 injured donors (ID) (41%) and 24 noninjured donors (ND) donors (59%). The control group consisted of 25 healthy volunteers matched for sex and age. We determined the following concentrations: antithrombin (AT), thrombin/antithrombin complexes (TAT), and prothrombin F1+2 fragments. The fibrinolytic parameter concentrations were: plasminogen (PL), plasmin/antiplasmin complexes (PAP), and D-dimers. RESULTS: Deceased kidney donors showed an increased plasma concentrations of TAT complexes (P<.000001) and prothrombin fragments F1+2 (P<.0000001); however, the protein C concentration was decreased (P<.000001). The antithrombin activity was similar to the control group. The concentrations of PAP complexes and d-dimers were higher (both P<.000001), but the level of PL lower among KD compared with controls (P<.0000001). The higher of TAT, PAP complexes, d-dimers, and F1+2 concentrations as well and as lower plasminogen and PC concentrations were evidence for increased activation of blood coagulation and fibrinolysis in cadaveric KD. However, analysis compairing ID versus ND donors revealed increased concentrations of PAP complexes (P<.05) and decreased amounts of TAT complexes (P<.01) among ID subgroup. The positive predictive value (PPV) and negative (NPV) for PAP complexes were 75% and 68% and for TAT, 71% and 57%, respectively. On the basis of these observations, we concluded that an intensive activation of fibrinolytic process occurs among the ID. In contrast, ND show intensive activation of blood coagulation.

The outcomes of treatment and the etiology of lymphoceles with a focus on hemostasis in kidney recipients: a preliminary report.

BACKGROUND: The etiopathogenesis of lymphoceles remains incompletely understood. The aim of our work was to analyze the perturbations of blood coagulation process for their possible impact on the etiology of lymphoceles. Additionally we performed an evaluation of the incidence and effectiveness of treatment methods for lymphoceles. MATERIALS AND METHODS: During 2004 to 2010, we performed 242 kidney transplantations in 92 female and 150 male patients. The hemostatic parameters included concentrations of: antithrombin, plasminogen, thrombin/antithrombin complexes (TAT), prothrombin products F1+2 (F1+2), d-dimers, and plasmin/antiplasmin complexes. RESULTS: At 7 years follow-up 27 (11%) recipients had developed symptomatic lymphoceles, namely abdominal discomfort, a palpable mess in the lower abdomen, arterial hypertension, infection of the operative site with fever, lymphorrhoea with surgical wound dehiscence, decreased diurnal urine output with an elevated plasma creatinine, voiding problems of urgency and vesical tenesmus, and/or symptoms of deep vein thrombosis. We applied the following methods of treatment aspiration alone, percutaneous drainage, laparoscopic fenestration or open surgery. In two only patients did perform open surgery. Since 2008 we have not performed an aspiration alone because of high rate of recurrence (almost 100%) and abandoned open surgery in favor of a laparoscopic approach. Our minimally invasive surgery includes percutaneous drainage guided by ultrasound and a laparoscopic procedure with 100% effectiveness. The examined hemostatic parameters revealed decreased concentrations of TAT complexes and F1+2 in subjects with lymphocele showing positive predictive values of 33% and 41% respectively. The negative predictive values for TAT complexes and F1+2 were 14% and 10%, respectively, suggesting decreased blood coagulation activity among effected recipients. Altered blood coagulation processes may explain some aspects of the disturbances of postoperative obliteration of damaged lymphatic vessels and formation of pathological lymph collection afterward. CONCLUSIONS: Perturbations of blood coagulation may be one cause for a lymphocele.

Minimally invasive methods for the treatment of lymphocele after kidney transplantation.

BACKGROUND: One common complication after kidney transplantation is a lymphocele. The aim of our work was an analysis of incidence of lymphocele and the effectiveness of minimal invasive methods in the management of this complication. MATERIALS AND METHODS: The examined group was consisted of 158 patients (68 female and 90 male) with end-stage renal disease who underwent kidney transplantation. RESULTS: Twenty-one patients (13%) developed symptoms of lymphocele after transplantation procedure within an average time of 34 weeks. The clinical symptoms included a decrease in 24-hour urine collection, an increase in plasma creatinine concentration, abdominal discomfort, lymphorrhea with a surgical wound dehiscence, voiding problems of urgency or vesical tenesmus, febrile states, or symptoms of deep vein thrombosis. The following methods were applied with variable efficacy: aspiration with recurrence 75%; percutaneous drainage with 55%, effectiveness; laparoscopic fenestration with 72% satisfactory outcomes (1 patient presented an excessive bleeding after the procedure), and classic surgery with favorable results. CONCLUSION: Percutaneous drainage guided by ultrasonic imaging should be recommended as the first attempt to cure a lymphocele. Laparoscopy is a feasible, safe technique that should be used after unsuccessful percutaneous drainage. A larger series of patients is required to confirm the superiority of minimal invasive methods to the classical approach.

Lymphocele after kidney transplantation.

BACKGROUND: One of the most often occurring complications after a kidney transplantation is a lymphocele. MATERIALS: The examined group consisted of 118 patients (70 males and 48 females) with end-stage renal disease (ESRD). RESULTS: Fourteen patients (12%) developed symptoms of lymphocele within an average time of 34 weeks. The clinical symptoms included the following: decreased 24-hour urine collection and increased creatinine level, abdominal discomfort, lymphorrhoea with surgical wound dehiscence, urgency, vesical tenesmus, and/or fever. Increased appearance of lymphocele was noticed in patients with diabetic nephropathy, congenital malformations of the urinary tract, and inflammatory diseases, including glomerulopathy and extraglomerular ones, after high-voltage radiotherapy and after removal of the renal graft. The methods of treatment and their efficacy were as follows: percutaneous aspiration with the ratio of recurrence 100%; ultrasound guided percutaneous drainage 50%; laparoscopic intraabdominal marsupialization 75%; and surgical intervention with favorable results. CONCLUSIONS: Ultrasound-guided percutaneous drainage with a success rate greater than 50% should be recommended as the first line of treatment. As a minimal invasive surgery this kind of treatment does not interfere with subsequent internal drainage through an open or a laparoscopic surgery. Laparoscopy, a feasible, safe technique with a success rate of more than 80%, should be used routinely after unsuccessful percutaneous drainage.

[Von Willebrand factor in plasma of patients with rheumatoid arthritis and lupus erythematosus]. / Czynnik von Willebranda w osoczu chorych na reumatoidalne zapalenie stawów i toczen rumieniowaty ukladowy.

The plasma levels of von Willebrand factor antigen (vWf:Ag) were evaluated for groups of 31 patients with rheumatoid arthritis and 34 patients with lupus erythematosus. The control group consisted of 34 healthy volunteers. In both groups the levels of vWf:Ag were increased to 243% and 240% respectively. The levels of vWf:Ag were also analysed statistically for the correlation with age of patients, time of the duration of disease and fibrinogen levels. No correlations were found. Obtained results suggest that measurements of vWf:Ag concentrations may be useful as potential marker of endothelial injury.

[Tissue type plasminogen activator antigen in urine of patients with bladder cancer]. / Antygen tkankowego aktywatora plazminogenu w moczu chorych na raka pecherza moczowego.

In urine of 25 patients with bladder carcinoma the antigen of tissue type plasminogen activator (t-PA) was assessed. The level of t-PA was much higher in patients with bladder carcinoma in comparison with a control group. We also analyzed the level of t-PA between patients with superficial and invasive bladder carcinoma the level of t-PA was higher. In conclusion, there is t-PA in urine of patients with bladder carcinoma and its level is correlated with staging of neoplasm.

[Tissue plasminogen activator in urine of patients with prostatic carcinoma and benign prostatic hyperplasia]. / Antygen tkankowego aktywatora plazminogenu w moczu chorych na raka i lagodny rozrost gruczolu krokowego.

In the 20 patients with prostatic carcinoma (PC) and the 18 with benign prostatic hyperplasia (BPH) the level of tissue type plasminogen activator (t-PA:Ag) was examined. As a compared group consisted of 24 healthy volunteers. In the urine of examined patients with PC and BPH and control the t-PA:Ag was absent or present only in trace amounts. We concluded that the t-PA:Ag in the urine of patients with PC can not be as a marker in the diagnosis of prostatic diseases especially in the prostatic carcinoma.

[Activity of antithrombin III in the blood of patients with bladder cancer]. / Aktywnosc antytrombiny III we krwi chorych na raka pecherza moczowego.

The activity of antithrombin III (AT III) in the blood of patients with bladder carcinoma was examined. It was shown an increase of AT III activity in comparison with control group. The changes of AT III activity in the blood of patients with bladder carcinoma can be the symptoms of an increased risk of haemorrhagic or thromboembolic complications.

[The influence of some surgical procedures on the activity of protein C]. / Wplyw niektórych zabiegów chirurgicznych na aktywnosc bialka C.

Protein C is the important regulating factor of coagulation and fibrinolytic system. It is known that surgery causes disturbances of haemostasis. The aim of work was to study the influence of different kind of surgery on the protein C activity. The study contained 102 operated patients in whom vascular operation (20), operation of prostate because of carcinoma (20) and hypertrophy (40), cholecystectomy (12) and operation of hernia (10) were performed. Protein C activity was measured using Kabi Diagnostika test applying chromogenic substrate. In the most of patients surgery caused on the 0 and 1st postoperative day the decrease of protein C activity and the return to the preoperative values in the next few days. The exception was the hernia operation which did not diminish protein C activity. It seems that the decrease of protein C after surgery was the effect of consumption of it in the extremely activated coagulation and fibrinolytic system during operation.

[Antithrombin III activity in blood of patients with renal cancer]. / Aktywnosc antytrombiny III we krwi chorych na raka nerki.

The activity of antithrombin III (AT III) in the blood of 20 patients with renal carcinoma was examined. An increase of AT III activity in comparison with control group was observed. The increase of AT III activity in the blood of the patients with renal carcinoma can be as a result of compensatory mechanism safing these patients before thromboembolic complication. The measurement of AT III in renal carcinoma can be a prognostic symptom of haemorrhagic and thromboembolic complications.

[The activity of alpha-2 macroglobulin in the blood of patients with prostatic carcinoma]. / Aktywnosc alpha 2-makroglobuliny we krwi chorych na raka gruczolu krokowego.

The activity of alpha 2-macroglobulin in the blood of the patients with prostatic carcinoma (PC) and benign prostatic hyperplasia (BPH) was examined. It was shown an decrease of alpha 2-macroglobulin in patients with prostatic carcinoma in comparison with control group consisted of the patients with benign prostatic hyperplasia. The low activity of alpha 2-macroglobulin in the blood od the patients with PC can be a symptom of an increase risk of haemorrhagic complications.

[The activity of protein C in the blood of patients with bladder carcinoma]. / Aktywnosc bialka C we krwi chorych na raka pecherza moczowego.

The activity of Protein C in the blood of patients with bladder carcinoma was examined. The average of Protein C activity was similar both in bladder carcinoma and in control group. The disperse of Protein C activity in bladder carcinoma was more greater than in control. In two patients with bladder carcinoma the bleeding with low activity of Protein C was observed. The low activity of Protein C in the blood of patients with bladder carcinoma can be the symptoms of an increased risk of thromboembolic complications.

[Fibrinolysis process in blood of patients with bladder carcinoma]. / Proces fibrynolizy we krwi chorych na raka pecherza moczowego.

In patients with bladder carcinoma a shorter ELT, and increased concentrations of EDP and t-PA were observed. These indicate on fibrinolysis activation caused by the released of t-PA. The increased fibrinolytic activity can be a cause of hemorrhagic complication occurring sometimes in bladder carcinoma. We observed much stronger activation of fibrinolysis in patients with an advanced bladder carcinoma.

[Antithrombin III and alpha 2-antiplasmin in blood of patients operated on for benign prostatic hyperplasia]. / Aktywnosc antytrombiny III i alpha 2-antyplazminy we krwi chorych operowanych z powodu lagodnego rozrostu gruczolu krokowego.

The pre- and postoperative activity was studied of antithrombin III (AT III) and alpha 2-antiplasmin (alpha 2-AP) in blood of 40 patients subjected to transurethral prostatic electroresection due to benign prostatic hyperplasia (BPH). For comparison of the obtained results a control group was formed from patients with other diseases of the genitourinary system with exception of neoplasms. The activity of AT III and alpha 2-AP before the operation was similar to that in the control group. Intraoperatively (day 0) and on the first day after the operation, a statistically significantly lower activity of AT III and alpha 2-AP was found in the patients with BPH in relation to the initial value as well as to the control group. On day 5 after the operation, normalization of AT III and alpha 2-AP activity was found. During operations of the prostate a release occurs of thromboplastins and plasminogen activators initiating the activation of blood clotting and fibrinolysis. The decrease of activity of AT III and alpha 2-AP could be caused by AT III and alpha 2-AP use-up in the process of inhibition of the created thrombin and plasmin.

[Activity of alpha 1-antitrypsin in blood of patients operated on for tumor and benign hyperplasia of the prostate]. / Aktywnosc alpha 1-antytrypsyny we krwi chorych operowanych z powodu raka i lagodnego rozrostu gruczolu krokowego.

The activity of alpha 1-antitrypsin in the blood of the patients with prostatic carcinoma and benign prostatic hyperplasia before and after the operation was examined. It was observed an increase of alpha 1-antitrypsin in the blood of patients with prostatic carcinoma and benign prostatic hyperplasia after the operation. In the blood patients of control group an increase of alpha 1-antitrypsin was observed too. The activity of alpha 1-antitrypsin in prostatic carcinoma was the highest during the whole observation period. The similar increase of the activity of alpha 1-antitrypsin after the operation in the blood of all groups of patients is connected with inflammatory reaction. The highest activity of alpha 1-antitrypsin in the blood of patients with prostatic carcinoma is the proof that the malignant neoplasm is associated with much more inflammatory reaction and the further hormonal treatment can be connected with a risk of thromboembolic complications.

[Levels of plasminogen and alpha 2-antiplasmin in blood of patients with prostatic tumor]. / Stezenie plazminogenu i alpha 2-antyplazminy we krwi chorych na raka gruczolu krokowego.

In the blood of 20 patients with prostatic carcinoma the level of alpha 2-antiplasmin and plasminogen were examined. The control group consisted of 20 patients with benign prostatic hyperplasia. The low activity of alpha 2-antiplasmin in the blood of the patients with prostatic carcinoma was observed. The level of plasminogen was similar in both groups and it was in the low part of laboratory normal range. We concluded that the low levels of plasminogen and alpha 2-antiplasmin were a result of their consumption during activation of fibrinolysis process. The measurement of the alpha 2-antiplasmin and plasminogen can be useful to predict a risk of bleeding complications in the patients with prostatic carcinoma and benign prostatic hyperplasia.

[Activity of alpha 1-antitrypsin in blood of patients with prostatic tumor]. / Aktywnosc alpha1-antytrypsyny we krwi chorych na raka gruczolu krokowego.

The activity of alpha 1-antitrypsin in patients with prostatic carcinoma and benign prostatic hyperplasia was examined. The activity of alpha 1-antitrypsin was higher in patients with prostatic carcinoma. The higher activity of alpha 1-antitrypsin is good prognostic sign for patients with prostatic carcinoma because it is born of large defense possibilities in these patients against the disease.

[Activity of protein C in blood of patients with prostatic carcinoma]. / Aktywnosc bialka C we krwi chorych na raka gruczolu krokowego.

The activity of Protein C in the blood of the patients with prostatic carcinoma and benign prostatic hyperplasia was examined. It was observed a slightly decrease of activity of protein C in the blood the patients with prostatic carcinoma. The observation of the activity of Protein C is useful because it allow to differentiate from patients with prostatic carcinoma a group of high risk of haemorrhagic complications. The activity of Protein C may be a prognostic factor of a progress of a prostatic carcinoma.